What is sundowning and how does it affect dementia?

Sunrise Senior Living  |  March 30, 2017

Sundown syndrome is a complicated and misunderstood symptom of dementia. Affecting 1 in every 5 people living with memory loss, it is important for loved ones to be mindful of sundowning symptoms and to carefully monitor the progression of the condition.

What is sundowning?

Sundowning, or sundown syndrome, is a phenomenon that increases feelings of confusion, anxiety, and other dementia symptoms later in the day, or as the sun goes down.   People with sundown syndrome often experience difficulty sleeping, which can further exacerbate memory loss.

Who does sundown syndrome affect?

The Alzheimer's Foundation of America stated that sundowning usually affects older adults in the mid to late stages of dementia. As the Alzheimer's Association reported, there is a link between memory loss and sleep patterns, but the exact correlation is unclear.

"1 in 5 individuals living with memory loss experience sundowning."

What causes sundown syndrome?
Although the majority of those living with sundown syndrome experience difficulty sleeping, scientists theorize a number of factors that might increase the chances of experiencing sundowning symptoms. First, symptoms may appear simply due to the exhaustion from a full day of physical and mental activities. Second, individuals living with memory loss may be affected by others' stress and exhaustion throughout the day, which further heightens their own stress. Third, changes in lighting may lead to changes in circadian rhythm, thereby causing stress and possible sundowning symptoms.

How can you reduce negative side-effects of sundown syndrome?

Because it's not entirely clear what causes sundowning, it can be hard to treat the issue directly. With that said, as a family member or caregiver, you can take proactive steps to reduce the negative effects of sundowning.

Keep a consistent schedule:

A consistent schedule is helpful for anyone living with memory loss, as changes or disruptions can be distressing. An inconsistent sleep schedule is both a risk factor and a symptom of sundowning, so a lazy morning can end up being detrimental. Plan to be active in the earliest parts of the day. The AFA advises that it's best to avoid midday naps.

Wind down earlier:

As the late afternoon and early evening approach, calm, simple activities are best. Over-stimulation can exacerbate confusion or restlessness. As a family member or caregiver, it's also important to prepare yourself for this time, as you may also suffer from fatigue later in the day.

Utilize Validation® therapy:

Validation involves more meaningful communication between the caregiver and the loved one living with dementia, allowing the caregiver the ability to enter his or her loved one’s world using empathetic techniques. Rita Altman, senior vice president of Memory Care and Program Services at Sunrise , is a proponent of this approach for those experiencing sundowning.

"As the day advances, not only may the person living with Alzheimer’s or a related dementia become more tired resulting in more restlessness or anxiety, but also their caregiver may be experiencing the stresses and strains of caregiving," she said. "That is why it is so vitally important for caregivers to learn and practice some Validation Therapy® techniques and approaches. The caregiver should remember to center often and especially when their loved one with memory loss is experiencing anxiety, or showing signs of anger or agitation."

She suggested speaking in a low, slow and calm demeanor, rather than with a loud tone at a fast pace. You can also turn on soothing music or try singing with your loved one to bring them to a happy state of being.

Keep in mind that appetite, hydration levels and other simple factors can play a role as well. Likewise, the way you work with an older adult to mitigate the symptoms of memory loss makes a big difference as well. Use this questionnaire to evaluate the type of care your loved one may need, and consider how subtle changes in your approach could make a meaningful difference.

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